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Incorporating Mental Health Services in a Public Health Setting

Incorporating Mental Health Services in a Public Health Setting. Confluence 2003 Promising Practice San Antonio Metropolitan Health District - SAMHD. Background.

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Incorporating Mental Health Services in a Public Health Setting

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  1. Incorporating Mental Health Services in a Public Health Setting Confluence 2003 Promising Practice San Antonio Metropolitan Health District - SAMHD

  2. Background • Central mission of the San Antonio Metropolitan Health District is provision of preventative and clinical services for women and young children • SAMHD has observed that significant proportion of women seeking care in clinics display symptoms of depression

  3. Purpose • Healthy Start requires screening for depression during perinatal period • Case review revealed 23% reported symptoms consistent with depression • To establish prevalenceof depression and to lay groundwork for programming (funded by Hogg Foundation for Mental Health)

  4. Overview Project Goals and Phases •Goals - Establish prevalence of perinatal depression - Establish triage and treatment system •Phases - Research - Implementation

  5. Research Qualitative • Learn how women interpret and express depression • Potential barriers to seeking care • Assist in selection of screening instrument Quantitative • Probability screening to determine prevalence

  6. Qualitative • 8 focus groups conducted among 49 women • Slightly more than 50% pregnant; less than 50% postpartum • Ages ranged from 15 to 37 years: - More than half fell between 15 and 20 years of age – youthful sample! CES-D instrument selected for use

  7. Quantitative • 3 interviewers hired to conduct depression screenings in SAMHD clinics • To-date, over 400 interviews have been completed • Demographic questions included in data collection • Interviewing to continue through end of August 2003

  8. Demographic Overview •93% of sample is Hispanic • 66% were born in Mexico • 64% of interviews conducted in Spanish language • 57% are married or living with someone

  9. Preliminary Findings - Prevalence

  10. Implementation • No-cost services available to clients through SAMHD: • Emergency consultation • Triage • Brief therapeutic intervention • Licensed Professional Counselor and 3 Licensed Master Social Workers • Graduate and Post-Graduate counseling students of Our Lady of the Lake University – San Antonio (Proposed)

  11. Implementation – Clinic Without Walls • Licensed professional mental health providers to provide pro-bono services to the community • Screening, intake and assessment services • Individual, group and family psycho-therapy • Psychotropic medication management if indicated • Emergency referrals

  12. Implementation – Case Management Case management services incorporated following policies: • All prenatal clients complete a CES-D interview when case is opened • Follow-up at 4-6 weeks postpartum • Referrals to mental health triage system which includes: • Student interns • In-house counselors • Clinic without Walls • Community mental health providers

  13. Discussion- Barriers Contractual/Legal • Institutional • Institutional “paradigm” • Role of mental health in public health often ignored • Clinic nurses constrained for time • Texas Policy • Mental health funding via Medicaid has been abolished for all adult clients including pregnant and postpartum mothers in the State of Texas

  14. Discussion – Next Steps • Strategies • Create additional relationships with local Universities for practicum and internship students • Obtain external funding sources to sustain efforts • Foster development of Mental Health Division within SAMHD

  15. Marivel Davila • Dora Baker • Sara Araujo • Michelle Pasos • Edmund H. Baca, Jr. • Monica E. Trevino • Yvonne Rodriguez • Melinda Navarro • Linda Hook, R.N. • Stephen K. Blanchard, Ph.D.

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